Universidad de Sta.

Isabel Vincentian Learning Module

College of Health Sciences HEALTH CARE ETHICS
Nursing Program Abbie Mae SJ. Panday, RN

Chapter 7: ETHICAL ISSUES RELATED TO TECHNOLOGY

AND DELIVERY OF HEALTH CARE

OVERVIEW

In the rapidly evolving landscape of healthcare, the integration of technology presents both
opportunities and ethical challenges. This overview examines key ethical issues concerning data
protection, security, and the delivery of healthcare services through technological advancements.

Key Topics

Data Protection and Security: Understanding the importance of safeguarding sensitive

personal information against unauthorized access and misuse is crucial. The principles of
availability, integrity, and confidentiality form the foundation of effective data protection
strategies.
Data Privacy Act of 2012 (RA 10173): This legislation aims to protect individual privacy
while facilitating the free flow of information. It regulates the processing of personal data
and establishes compliance standards for healthcare entities, ensuring alignment with
international data protection norms.
Benefits of Technology in Healthcare: Technology streamlines healthcare services,
enhances care coordination, improves population health management, and enriches patient
education. These advancements contribute to more efficient healthcare delivery and better
patient outcomes.
Challenges of Technology: Despite its benefits, technology poses significant challenges,
including high costs, interoperability issues, and the potential for ethical dilemmas in patient
autonomy and decision-making.
Current Issues and Dilemmas: The application of technology raises questions about
privacy and security, particularly regarding patient data in digital health settings. Ethical
considerations related to sociotechnical systems emphasize the need for a holistic approach
to technology's impacts on healthcare.

At the end of this lesson, you will be able to:

1. Understand the principles of data protection and security in healthcare.

2. Analyze the implications of the Data Privacy Act of 2012 (RA 10173) on healthcare
practices.
3. Identify the benefits and challenges of technology in healthcare delivery.
4. Evaluate current issues related to privacy and security in healthcare technology.

A. Data Protection and Security

Data Protection is the act of protecting information, both sensitive and personal sensitive
to unauthorized access and use.

Protection has various advantages. It allows employees to safely share shared logical and
physical address spaces. In terms of logical address spaces, for example, if a directory of data
files must be shared by several users, protection measures such as digital signatures and

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences HEALTH CARE ETHICS
Nursing Program Abbie Mae SJ. Panday, RN

encryption can aid in the process of safe sharing. Staff have particular authorization to access
the information needed to execute their duties, but that is it. Different users can access a
system's memory via physical address spaces inside a system, boosting resource efficiency.

Security is typically defined by three main attributes: availability, integrity, and confidentiality.

• Availability relates to the prevention of unauthorized actors withholding information,

for as during a ransomware assault. Meanwhile, confidentiality and integrity are
concerned with information staying private, undamaged, and undamaged by malevolent
actors.

External dangers are often classified as either indirect or direct. A Trojan, worm, or
computer virus are examples of random indirect threats, whereas a targeted attack by a hacker
is an example of a direct danger.

Both protection and security strategies aim for a secure and successful system, but they
target different risks. Protection manages hazards within systems, while security addresses
threats from outside systems to ensure system operation and effectiveness.

Security and protection are two distinct concepts. Security policy, implemented by
system administrators, restricts user access to a system, while protection policy controls access
to data, processes, and programs. Security protects user and system resources from
unauthorized entities, while protection provides a framework for controlling access. Preventative
measures like permissions, encryption keys, electronic signatures, and data vaults are used to
secure data and resources. External threat defense systems like firewalls and antivirus software
can also be used to delete users no longer authorized to use systems.

Implications to Practice

Healthcare services depend significantly on the unrestricted dissemination of information

among all stakeholders, including the patient, the healthcare provider, and the medical
institution. Clients are more inclined to provide comprehensive and precise data when they are
assured that their information is protected and secure with their healthcare provider. A health
organization that prioritizes data privacy demonstrates a commitment to its patients.

The majority of the data you handle as a healthcare provider is categorized as sensitive
personal information. Data privacy measures ensure the protection and security of your client's
information.

It guarantees the security of their data at all times, safeguarding it against threats such
as unauthorized access, processing, sharing, and disclosure.

DATA PRIVACY ACT (National Privacy Commission, 2021)

Republic Act No. 10173 is also known as the Data Privacy Act of 2012 (DPA). It (1) protects the
privacy of individuals while ensuring free flow of information to promote innovation and growth;
(2) regulates the collection, recording, organization, storage, updating or modification, retrieval,
consultation, use, consolidation, blocking, erasure or destruction of personal data; and

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences HEALTH CARE ETHICS
Nursing Program Abbie Mae SJ. Panday, RN

(3) ensures that the Philippines complies with international standards set for data protection
through National Privacy Commission.

The National Privacy Commission (NPC) is the country's privacy watchdog; an independent
body mandated to administer and implement the DPA, and to monitor and ensure compliance
of the country with international standards set for data protection.

Who are covered by the DPA?

The DPA applies to the processing of all types of personal information and to any
natural or juridical person involved in personal information processing, including personal
information controllers and processors who, while not located or established in the Philippines,
use equipment located in the Philippines, or those who maintain an office, branch, or agency in
the Philippines subject to the immediately following paragraph: Provided, That the
requirements of Section 5 are complied with.

Does the hospital or health care setting need a Data Privacy Officer?

The Data Privacy Act of 2012 mandates the appointment of a Data Protection Officer
(DPO) for personal information controllers (PICs) and personal information processors (PIPs) in
the Philippines. A DPO is required for any natural or juridical person or body in the government
or private sector involved in processing personal data of individuals. An individual PIC or PIP is
considered a de facto DPO. However, mere appointment is not enough compliance; it must be
coupled with DPO's registration at the National Privacy Commission (NPC). PICs or PIPs involved
in processing personal data that pose a risk to data subjects' rights and freedoms are subject to
mandatory registration of their DPOs and data processing systems.

In the healthcare industry, PICs include hospitals, multi-specialty clinics, and specialized
out-patient facilities. Individual health professionals should register as de facto DPOs if they
process sensitive personal information of at least 1000 individuals. Voluntary appointment and
registration of a DPO can provide numerous benefits. In today's information age, assigning a
focal person to ensure data protection is essential for organizations to remain competitive in the
global data protection landscape.

What is a Privacy Notice?

A privacy notice is a statement about an organization's collection, use, retention, and

disclosure of personal information, also known as a privacy statement, fair processing statement,
or privacy policy. It must be easy to read, transparent, and compelling, and differ from consent.
Health providers must understand the availability and accessibility of this information.

What is a Privacy Impact Assessment (PIA)?

Privacy Impact Assessment (PIA) is a process used to evaluate and manage the privacy
impacts of a program, project, process, measure, system, or technology product of a Public
Interest Corporation (PIC) or Public Interest Group (PIP). It considers the nature of the personal
data, data flow, privacy and security risks, current best practices, security implementation costs,
and the organization's size, resources, and operational complexity. PIA helps PICs or PIPs
understand data flows, identify privacy risks, and propose measures to address them.

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences HEALTH CARE ETHICS
Nursing Program Abbie Mae SJ. Panday, RN

What is a Privacy Management Program?

A Privacy Management Program (PMP) is a strategic process that integrates privacy and data
protection into a PIC's daily operations. It involves organizational commitment and oversight of
coordinated projects and activities. The PMP ensures everyone understands the purpose,
expected results, benefits, and necessary actions, facilitating smooth communication and
alignment with management and staff, ultimately promoting a more inclusive and effective
approach.

Personal Data Protection Measures in PICs

• PICs or PIPs are required to protect personal data from natural and human dangers.
• Measures include accidental loss or destruction, unlawful access, fraudulent misuse, unlawful
destruction, alteration, and contamination.
• Each PIC or PIP is required to produce a Privacy Manual to inform personnel of these
measures.
• The Manual guides compliance with the DPA, its IRR, and other National Privacy Commission
issuances.
• It outlines privacy and data protection protocols for specific circumstances.

Data Processing Guidelines

Under the Data Privacy Act (DPA), consent from the data subject is defined as a
voluntary, specific, and informed expression of will, where the individual agrees to the collection
and processing of their personal information. It's important to note that consent is just one of
several lawful grounds for processing personal information (as outlined in Section 12 of the DPA)
and sensitive personal information (in Section 13). When handling data, Personal Information
Controllers (PICs) should assess whether consent is the most appropriate basis for processing.
Consent can be documented through written, electronic, or recorded means, and it may also be
provided by an authorized agent acting on behalf of the data subject.

What is the consent of the data subject?

To protect privacy, the law requires organizations to notify and furnish their data subjects with
the following information before they enter personal data into any processing system, or at the
next practical opportunity:

1. Description of the personal data to be entered into the system

2. Purposes for which data will be processed (e.g. direct marketing, statistical, scientific
etc.)
3. Basis for processing, especially when it is not based on consent (e.g. public health and
safety, mandatory reporting of illness, disease surveillance)
4. Scope and method of the personal data processing
5. Recipients to whom data may be disclosed
6. Methods used for automated access by the recipient and the extent to which such
access is authorized
7. Identity and contact details of the PIC or its representative
8. The duration for which data will be stored
9. Existence of the rights of the data subjects

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 Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences HEALTH CARE ETHICS
Nursing Program Abbie Mae SJ. Panday, RN

What are the guidelines in collecting and accessing personal data?

The Commission has frequently emphasized that health practitioners and all those
involved in providing healthcare services should only collect the necessary personal information.
Recipients should not face personal data requirements that exceed what is absolutely essential,
as this could hinder the timely provision of care during critical times. Access to health data
should be limited to a "need-to-know" basis, meaning that only members of the healthcare team
should have the minimal and essential access required to perform their duties.

What do I need to keep in mind when storing clients' information?

The DPA and its IRR provides that personal data shall not be retained longer than necessary:

1. for the fulfillment of the declared, specified, and legitimate purpose, or when the
processing relevant to the purpose has been terminated;
2. for the establishment, exercise or defense of legal claims; or
3. for legitimate business purposes, which must be consistent with standards followed by
the applicable industry or approved by appropriate government agency.
Likewise, retention of personal data shall be allowed in cases provided by law.

Members of the Health and Hospitals Sector can refer to DOH Memorandum Circular No. 70,
series of 1996, which outlines the Revised Disposition Schedule for Medical Records.
Furthermore, a Personal Information Controller (PIC) is required to establish reasonable and
appropriate organizational, physical, and technical measures to safeguard personal information
from accidental or unlawful destruction, alteration, disclosure, and any other form of unlawful
processing.

How may personal data be disposed of?

According to the Implementing Rules and Regulations (IRR), personal data must be
disposed of securely to prevent further processing, unauthorized access, or disclosure to third
parties or the public, thereby protecting the interests of the data subjects. The Data Privacy Act
(DPA) imposes penalties for the improper disposal of both personal information and sensitive
personal information.

Relevant Issues and Concerns of Data Privacy to COVID-19 Response

1. What are the guidelines when conducting contact tracing?

On April 17, 2020, the Department of Health (DOH) issued Department Memorandum No. 2020 -
0189, which provides Updated Guidelines for Contact Tracing of Close Contacts of Confirmed
COVID-19 Cases. This memorandum outlines how to conduct effective contact tracing while
respecting data privacy and the rights of individuals.

In this context, the Commission, through NPC PHE Bulletin No. 13, highlighted that successful
contact tracing relies on mutual trust between public health authorities and the public. Accurate
information from citizens is essential for effective contact tracing. However, the public needs to

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences HEALTH CARE ETHICS
Nursing Program Abbie Mae SJ. Panday, RN

trust that authorities will balance the risks to their rights and security with the potential benefits
to public health, ensuring that their data is processed fairly, lawfully, and securely.

Additionally, organizations must ensure that the systems and applications used for contact
tracing are designed with data privacy in mind. Protecting the rights of data subjects should be a
core function of these systems, rather than just an added feature. This approach is known as
privacy by design. Therefore, digital contact tracing systems should undergo thorough Privacy
Impact Assessments (PIAs) to identify and address risks and vulnerabilities as early as possible.

2. Can I share information about COVID-19 patients?

Following the declaration of a health emergency in the country, the NPC issued PHE Bulletin No.
6, which stated that data sharing and disclosure related to COVID-19 patients should only occur
with the appropriate authorities. While there are laws permitting the transfer of information
about COVID-19 patients between institutions, Personal Information Controllers (PICs) must limit
such sharing to the minimum necessary, adhering to the three key data privacy principles:
transparency, legitimate purpose, and proportionality. Additionally, even if a Data Sharing
Agreement (DSA) is not legally required, PICs and Personal Information Processors (PIPs) may
choose to create one to clarify the terms and conditions of data sharing or to outline security
measures.

3. Can I publicly disclose the identities of COVID-19 patients?

Contact tracing does not require public disclosure of identities of COVID-19 patients.
Unbridled disclosure of patients' personal data to the public has been proven to cause actual
harm such as physical assault, harassment, and discrimination. The DPA has never been a
hindrance to contact tracing. It does not prevent the processing of personal data when
necessary to fulfill their mandates.

B. Benefits and Challenges of Technology

Technology has its advantages on the health care system primarily on streamlining the services
and makes the workload of healthcare professionals lighter and more efficient. Specifically, the
three major benefits of technology in healthcare according to Ross (2019) are as follows:

1. Improved Care Coordination

Enhancing coordination has long been a priority in healthcare, serving as a fundamental

aspect of The Joint Commission's National Patient Safety Goals program and a
requirement for meaningful use attestation. Despite growing attention to this issue, care
coordination continues to pose challenges for organizations, particularly during
transitions of care, which can lead to reduced quality and safety of care. A report by the
Center for Healthcare Research & Transformation estimates that poorly coordinated
transitions from hospitals to other care settings cost between $12 billion and $44 billion
and are linked to negative health outcomes such as medication errors, complications
from procedures, infections, and falls. Fortunately, advancements in technology offer
promising opportunities to enhance communication among providers and reduce errors
during these transitions.

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences HEALTH CARE ETHICS
Nursing Program Abbie Mae SJ. Panday, RN

In response to the growing demand for support in managing care transitions, innovative
IT companies have developed a variety of solutions. Some of these technologies are
standalone systems and applications designed specifically to facilitate the transfer of
care, while others are bundled with additional products addressing broader issues like
communication, education, and medication adherence.

2. Improved Population Health Management

Population health is a novel term that may be described as "the health result of a group
of individuals, including the distribution of such outcomes within the group," according
to an article published by Barton Associates. "Without data on the [health] populations
you serve," Evan Wade of Barton Associates writes, "any population health initiatives
become educated guesses at best." According to a survey conducted by West Corp.,
35% of all respondents, including hospital and health system providers, physicians, and
other medical professionals, did not have adequate access to clinical data from disparate
systems.

3. Improved Patient Education

Patient education used to be mostly based on written information regarding illness

processes, medications, medical management, and self-care teaching instructions.
Patients may now get health information from anywhere thanks to the Internet and
mobile technologies.
Telemedicine advancements now allow people to consult with a healthcare expert
anytime they need one. New education formats, such as interactive walkthroughs,
instructive films, and SMS reminders, provide patients with new ways to absorb health
information and become more involved in their treatment.
Furthermore, enhanced functionality in current technologies, such as patient portals, can
provide patients with personalized health education information based on their unique
requirements and situations.

Challenges of Technology in Healthcare

The challenges of technology in healthcare can be viewed into three categories according to
Zarif (2022) namely:

1. Healthcare Organizations

The expense of technology is one of the most significant difficulties for enterprises in
terms of installation and subsequent upkeep.
The inability to precisely measure intangible patient and cost advantages makes
valuing and justifying capital spending on new technologies problematic. When
compared to broad deployments, remote monitoring may be viewed as a
compromise.
Proponents say that reducing needless hospitalization can reduce healthcare
expenses, which may be especially important in chronic illness management. This is
advantageous from a utilitarian standpoint in terms of achieving successful
outcomes for as many patients as feasible. However, the evidence reveals that
remote monitoring does not save costs for the great majority of people.

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences HEALTH CARE ETHICS
Nursing Program Abbie Mae SJ. Panday, RN

Most studies according to Zarif (2022) show little, if any, cost reductions and
occasionally increased expenses; nevertheless, favorable clinical results for chronic
illness treatment have been observed. According to Rawls' Difference Principle, the
literature is not in favor of cost-cutting measures that help the majority of the most
vulnerable people. It has been proposed that remote monitoring may possibly incur
higher expenditures for underrepresented communities. As a result, it is vital to
avoid developing a false feeling of organizational autonomy, which might lead to a
shift in the healthcare organization's role from a patient-centered to a profit-
centered agenda.
Interoperability is a concern raised by the idea of "new" technology. Integration and
cross-access of data and use between multiple systems or even different versions
may be problematic due to the timeframes involved. This, according to some, is a
blatant breach of organizations ethical responsibilities, arising from their fiduciary
connection with patients, to guarantee that the absorption of old systems meets
integration criteria (Zarif, 2022).

2. Healthcare Providers
Despite the fact that healthcare technology offers great opportunities to enhance
healthcare outcomes, improper use must be addressed. The technological imperative
relates to the inevitability of new technology and its necessary character, which
indicates the necessity for adoption for social benefit. The dominance of technology
in healthcare arguably modifies the objective of healthcare from preservation and
restoration under responsible autonomy to death prevention.
This raises the moral plight of utilizing the patient as a way of achieving end-of-life
prevention, so breaching one of the core guiding principles of medical ethics:
autonomy. To get deeper into this, we must look at the origins of morality. The use
of the imperative suggests a hasty decision with minimal leeway. This escalates to
the point that it is unimaginable for doctors to refuse treatment). Thus, the moral
imperative is derived from a social process-mediated genesis, such that, while
innovative technology is not required to be employed, the imperative brings about
normalcy through routinization and is symptomatic of how the social environment
has impacted the perception of its efficacy.

3. Patients
The implications of the moral obligation bleed over into the issues that patients face.
The necessity to assure appropriate use of costly equipment (at least during the
early adoption period) and the moral obligation to use new technology directly
contradicts the need to protect patient autonomy, as drawn from the application of
personalism to healthcare systems.
Their manifestation is their one-of-a-kind worth, which includes inherent attributes
like free will. The person's participation in decisions centered on them has the ability
to achieve their causal potential. Thus, the challenge to the moral imperative is a
clear breach within the patient-centered paradigm of modern medicine.
The position of technology, on the other hand, does not have to be limited to a false
dichotomy of either the value-neutrality dictum or the value-ladenness thesis. The
acceptance of technical value does not mean our subjection to the technological
imperative and loss of autonomy. Zarif (2022) on Cassell contends that the value-
ladenness of technology stems from its inherent features, which correlate to human
nature's shortcomings. Thus, managing the value-ladenness of technology involves

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences HEALTH CARE ETHICS
Nursing Program Abbie Mae SJ. Panday, RN

governance of our values and self-control, whereas managing its ethical issues
necessitates management of our ethos.

Current Technology: Issues and Dilemma

1. Privacy and Security

The issue of privacy and security will always be in question once technology is applied in
the healthcare setting. Autonomy and transparency relates to this issue as to what
choice can the patient make. According to Shaw and Donia (2021) it is in the interest of
technology developers and other supporters of digital health to keep attention focused
on technical challenges that can be contained and addressed using technical
approaches.

2. Sociotechnical Health

Shaw and Donia (2021) describe "sociotechnical" as the understanding that issues
related to technologies, such as digital health applications, involve not just the
technologies themselves but also the social contexts in which they are developed and
used. They emphasize that "social arrangements" are intertwined with various
technologies, from design room tools to smartphone apps and videoconferencing
software that facilitate interactions. The term "sociotechnical" thus expands the focus
from technology-specific issues to the broader implications of how technologies are
integrated into social environments, influencing, and being influenced by human
experiences.

The sociotechnical approach introduces new ethical considerations that must be accounted for in
the analysis of technologies, shifting the focus to the kind of world we aspire to create through
their design and use. Rather than merely assessing predefined ethical issues, this approach
encourages exploration of a broader range of related ethical concerns that may impact our
goals. Ethical analysis is deemed incomplete without recognizing these wider issues, particularly
regarding their implications for achieving desired outcomes. For instance, when designing a
digital health technology, one might also need to examine the influence of for-profit technology
companies on health policy within a specific jurisdiction.

2.1. Application Software

Shaw and Donia (2021) identify ethical issues related to application software, which
include effectiveness, usability, inclusiveness, transparency, and other factors affecting
the use of digital health tools.

2.2. Material Devices and Supply Chains

Ethical considerations often overlook the materials used in digital health devices, but
these are crucial for a comprehensive understanding of digital health ethics. The
materials, sourced globally, often rely on low-wage labor in low-income countries while
benefiting large corporations in wealthier nations.

2.3. Infrastructures

Infrastructures encompass the hardware and software necessary for digital devices to
function. This includes the physical spaces where healthcare providers deliver virtual

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences HEALTH CARE ETHICS
Nursing Program Abbie Mae SJ. Panday, RN

care and the technologies that enable communication. Ethical issues arise, such as the
lack of high-speed internet access, which can prevent certain communities from utilizing
digital healthcare services.

2.4. Individual Health-Related Practices

Digital health technologies often include self-tracking features that encourage individuals
to monitor their behaviors, aligning them with social norms. Ethical concerns include the
influence of these technologies on mental well-being, self-esteem, and individual
behaviors, highlighting the need to consider these factors in ethical analyses.

2.5. Interpersonal Relationships

Technologies can significantly impact interpersonal relationships, particularly through

social media, which can shape public understanding of health issues and reinforce
specific viewpoints. Additionally, technology-mediated communication affects the
dynamics between healthcare providers and patients.

2.6. Organizational Policies

Digital technologies can transform daily work practices and the overall structure of
healthcare organizations. How these organizations manage the shift from analog to
digital environments will have significant implications for healthcare work and patient
care.

The operation of healthcare systems is a public interest concern, which expands the
ethical issues relevant to analyzing digital health. A key consideration is the influence of
organizations like insurance companies that utilize digital health technologies to gather
data on individual behaviors and adjust their products accordingly. As these
technologies advance, their role in the insurance sector raises important organizational
policy questions that require thorough ethical examination.
In conclusion, the digitalization of healthcare workflows is permanent. A socio-technical
approach to ethical analysis is essential to address the concerns associated with
technology use. By prioritizing usability and ethical considerations, developers and
healthcare professionals can ensure that both aspects work together effectively.

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences HEALTH CARE ETHICS
Nursing Program Abbie Mae SJ. Panday, RN

REFERENCES:

National Privacy Commission (2021). Frequently Asked Questions on Data Privacy Act in the
Health and Hospital Sector. https://www.privacy.gov.ph/wp=

content/uploads/2021/03/Brochure Health-Sector.pdf

Ross, S.M. (2019). 3 Benefits of Technology in HealthCare. https://blog.cureatr.com/3-

benefits-of-technology-in-healthcare

Shaw JA and Donia J (2021) The Sociotechnical Ethics of Digital Health: A Critique and Extension
of Approaches From Bioethics. Front. Digit. Health 3:725088, doi:
10.3389 / fdgth.2021.725088

Zarif, A. (2022). The ethical challenges facing the widespread adoption of digital healthcare
technology. Health Technol. 12, 175-179 (2022). https://doi.org/10.1007/s12553-021-00596-w

-End of this Module-

THANK YOU, BSN 2 STUDENTS.

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